The invention generally relates to treating a urinary bladder.
Interstitial cystitis (IC) is a chronic inflammation or irritation of the urinary bladder wall that is estimated to affect between 500,000 and 1,000,000 people in the U.S. (approximately 90% female). The primary symptoms of IC are urinary urgency, frequency, and often-severe pelvic and perineal pain. The similarity of the symptoms of IC with other bladder diseases, such as urinary tract infections (UTI), urethritis, urethral syndrome, trigonitis, prostatitis, dysuria, and nocturia has caused difficulty in the diagnosis of the disease. After other similar bladder diseases are ruled out and a cystoscopic examination of the bladder wall reveals characteristic signs of IC, including small petechial hemorrhages or larger Hunner""s Ulcers, IC is usually diagnosed.
The biological cause of IC remains undetermined. The theory that IC is caused by a bacterial infection is controversial. IC patients routinely test negative for infection in standard urinalysis. On the other hand, several studies have shown antibiotic treatment regimens to alleviate symptoms for IC patients. Another possible cause is a defect in the epithelial permeability barrier of the bladder surface glycosaminoglycans (GAG). Once the bladder wall loses the protective coating of GAG, irritative components and potentially pathogenic bacteria in the urine can lead to the inflammation or irritation associated with IC. Another line of research indicates that activated mast cells, which are associated with pain and irritation, are involved in the pathology of IC. Studies have shown that IC patients have an increased level of activated mast cells in the tissues of the bladder wall.
Currently there is no permanent cure for IC in the majority of patients. Treatment of IC with drug therapy has been proven to be the most effective means of alleviating symptoms. Oral medications for IC include bladder-coating agents, antidepressants, antihistamines, antispasmodics, and anesthetics. The effectiveness of oral medications is limited by the circulating concentration of the drug in the blood stream. To address this limitation, many IC patients elect to undergo a procedure called urinary bladder instillation, in which a therapeutic solution is pumped into the bladder through a urethral catheter. The solution, which may be composed of one or a combination of medications, is held in the bladder for a xe2x80x9cdwell timexe2x80x9d before the bladder is drained or voided. This procedure allows the treatment of the urinary bladder wall directly with high concentrations of medicine. Despite the drawbacks of a limited dwell time for the medication to take effect and the necessary mixture of medication with urine, bladder instillation may be the most effective treatment currently available for IC.
The current urinary bladder instillation procedure for IC patients can be made more effective by increasing the dwell time and/or by using medication undiluted by urine. The invention generally relates to devices and ways for increasing dwell time in bladder instillations and/or for preventing dilution of the medication(s) used in bladder instillations.
Generally, the invention can feature a device for substantially isolating urine from the urinary bladder wall to give the bladder mucosal layer sufficient time to heal. The device can include a bladder, liner, or sack designed to fit inside the urinary bladder. The liner functions as an inner bladder for the urinary bladder and serves to protect the urinary bladder wall from contacting urine. Preventing urine from contacting the urinary bladder wall serves multiple therapeutic purposes. First, it allows the urinary bladder wall to be treated with medications without the medications being diluted by urine. Second, because the medications applied to the urinary bladder wall are prevented from mixing with the urine, they are not flushed out of the body following the voiding of the bladder. Third, the urinary bladder wall is protected from the caustic nature of the urine allowing for a more rapid healing process.
In general, the invention also can feature a system of catheters that connect to the ureteral orifices proximal to the urinary bladder and convey urine to an exterior urine collection bag or container. This device would provide similar therapeutic benefits as the urinary bladder liner by preventing urine from collecting in the urinary bladder or contacting the urinary bladder wall in any significant quantity. This device generally uses an external urine collection container to collect any urine flow resulting from the urinary bladder by-pass.
In one aspect, the invention relates to a medical device including a urinary bladder liner. The liner is adapted to fit within a patient""s urinary bladder. The liner has a reservoir and two inlet orifices that are adapted to sealably connect to respective ends of the patient""s ureters and an outlet orifice adapted to extend into the patient""s urethra. The liner isolates urine from the urinary bladder. In various embodiments of the invention, the outlet orifice is adapted to sealably connect to the urethra and/or extend through the urinary sphincter and/or connect to a catheter that extends through the urinary sphincter. In other embodiments of the invention, the inlet orifices are connected to catheters that are adapted to sealably connect to the respective ureter openings. Alternatively, the catheters are adapted to extend through the patient""s ureters and into the patient""s kidneys. The distal ends of the inlet catheters may be coiled to fit in a kidney basin. The inlet catheters may include a plurality of fins mounted on exterior surfaces of the catheters and adapted to form a liquid-impermeable seal with a wall of each ureter.
In further embodiments, the outlet orifice or outlet catheter is made of a material sufficiently flexible so that the orifice or catheter can be completely compressed by the urinary sphincter. In addition, the sealable connections can be made with a biocompatible adhesive. Alternatively, the sealable connections can be created by the expansion of an outer wall diameter of an end of the catheter that contacts the body, which functions to fix the catheter end in place and to form a liquid-impermeable seal. In addition, the liner can be made of a pliant material, and/or a material chosen from silicone, vinyl, polyethylene, PVC, latex, ethylene vinyl acetate, and polypropylene, and/or a material that stretches and shrinks. Also, the liner can be coated with a heparin-like drug or a slippery material, such as a hydrogel, on the outer surface.
In yet another aspect, the invention relates to an apparatus for isolating urine from a patient""s urinary bladder. The apparatus includes a first catheter and a second catheter, each including a proximal and a distal end. The proximal ends of the first and second catheters are adapted to sealably connect to the patient""s ureter walls. The distal ends of the first and second catheters pass through the patient""s urinary sphincter. Alternatively, the first and second catheters may each pass through a suprapubic incision in the patient""s abdominal wall. The apparatus also includes an external urine collection container that is connected to the distal ends of the first and second catheters. In one embodiment, the first and second catheters include valves disposed between the distal ends of the catheters and either a distal end of the patient""s urethra or the suprapubic incisions. The valves control the flow of urine to the collection container.
In one embodiment, the first and second catheters are joined together to form a third catheter. A proximal end of the third catheter is connected to and joins the distal ends of the first and second catheters. The distal end of the third catheter passes through the patient""s urinary sphincter. Alternatively, the third catheter may pass through a suprapubic incision in the patient""s abdominal wall. An external urine collection container is connected to a distal end of the third catheter. In some embodiments, the third catheter includes a valve disposed between either a distal end of a urethra or the suprapubic incision and the distal end of the third catheter for controlling the flow of urine to the collection container. In some embodiments, the seals are composed of biocompatible adhesives and/or the catheters are composed of materials comprising biocompatible plastics. In addition, the catheters can be made of materials chosen from silicone, vinyl, polyethylene, PVC, latex, ethylene vinyl acetate, and polypropylene.
In still another aspect, the invention relates to a method of treating urinary bladder diseases. The method includes the steps of isolating urine from a urinary bladder and treating the urinary bladder with appropriate medications. Appropriate medications include oral medications and/or topical medications. Typically, topical medications are instilled between a wall of the bladder and the bladder liner. The step of isolating the urine from the urinary bladder includes inserting a urinary bladder liner into the bladder. In another method, the step of isolating urine from the urinary bladder includes inserting an apparatus that carries urine from the ureter orifices to an external urine collection container. In one embodiment, the apparatus exits the patient""s body through the urinary sphincter. In another embodiment, the apparatus exits the patient""s body through one or more suprapubic incisions through the patient""s abdominal wall.
These and other objects, along with advantages and features of the present invention herein disclosed, will become apparent through reference to the following description of embodiments of the invention, the accompanying drawings, and the claims. Furthermore, it is to be understood that the features of the various embodiments described herein are not mutually exclusive and can exist in various combinations and permutations.